Peanut Allergies: What You May Not Know

Author: Sherry Coleman Collins, MS, RDN, LD

Food allergies are a common concern among new parents and other caregivers of young children. However, research shows that there are many misconceptions about food allergies, which may lead to unnecessary anxiety. The National Academies of Science, Engineering and Medicine (NASEM) recently released an expert report with the goal of understanding better what we know and don’t know about food allergies. Titled Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management and Public Policy, the report provided a variety of key messages about food allergies. Some of the important issues raised include misperceptions and misinformation, diagnosis, and the need for more education and improved education.

Misperceptions May Drive Fear

According to the report, food allergy is a public health concern, with no effective treatment available. Moreover, many misperceptions about identification, prevention, and management persist among doctors, patients and the general public. Some misperceptions may drive unnecessary fears and lead to negative quality of life for those with food allergies. One primary misperception about peanut allergies is the belief that just being in the presence of peanut foods will cause anaphylaxis. In fact, research has shown that just smelling peanut butter or having it on the skin did not result in respiratory or severe reactions or anaphylaxis. (Simonte S, 2003) In addition, peanut protein is very heavy and settles quickly. In simulated eating episodes, peanut protein was undetectable in the air as researchers ate peanut butter and shelled peanuts. (Brough H, 2013) The only time peanut protein was detectible was immediately after peanuts were shelled and only for a very short distance and it settled in seconds.

Simple, Accurate Testing is Needed

Another issue raised by the report is that there are no simple diagnostic tests for food allergy, and their interpretation requires expertise. Skin prick and serum IgE blood tests suggest the likelihood of food allergy, but do not diagnose food allergy alone and these should not be used as screening tools in the absence of specific symptoms to specific foods. In fact, one study found that in spite of positive tests, 84-93% of foods avoided could be reintroduce to the diet after oral food challenges. (Fleischer D, 2011) While oral food challenges are the gold standard, these carry risks, are expensive and are often underutilized.

Experts agreed, per the report, that there is no estimate of true prevalence of food allergy in the U.S., because no truly representative study of adequate size has been conducted and those that have been done likely overestimate prevalence. This explains why there are varying and different numbers used by groups who provide information and education about food allergies. Most reports and studies that estimate prevalence have used self-reported data, which is subject to inherent biases and inaccuracies. In fact, 50-90% of presumed food allergies are inaccurate. (NIAID-Sponsored Expert Panel, 2010)

Areas of Opportunity in Training, Research, Labeling

The report also outlined some other important areas of opportunities. The report recommended improved education and training about food allergy among healthcare and emergency care providers, foodservice, and governmental agency personnel. The report emphasizes that anaphylaxis can occur anywhere and proper emergency management can save lives. Additional research was also recommended, including in the area of prevention and improving food allergy safety. Additionally, U.S. labeling could be improved to better inform consumers about the risks from food allergens, particularly in voluntary precautionary (“may contain”) labeling.

A primary take-away from the report is that much more quality research is needed to better understand food allergies. This is a dynamic area of practice and research in healthcare. Sherry Coleman Collins, registered dietitian nutritionist and food allergy expert, said, “Practitioners should keep abreast of changing research, expert recommendations and emerging guidelines in the area of food allergies in order to provide the best evidence-based care.” To help in this area, the National Peanut Board has created a resource for healthcare practitioners, parents and caregivers, and others interested in peanut allergies at PeanutAllergyFacts.org.